EHR and Health IT Consulting
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EHR and Health IT Consulting
Technical Doctor's insights and information collated from various sources on EHR selection, EHR implementation, EMR relevance for providers and decision makers
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For Stage 2 Meaningful Use Attestation, Pick a Larger EHR Vendor

For Stage 2 Meaningful Use Attestation, Pick a Larger EHR Vendor | EHR and Health IT Consulting |

Larger EHR vendors tend to make better partners in achieving Stage 2 Meaningful Use, according to a recent study by Peer60. The study, which discusses insights and trends in EHR vendors, sought to identify the which vendors play a bigger and more supportive role in providers’ work to achieve meaningful use.

According to the report, users of notable vendors such as Epic, Cerner, and Allscripts stated that these technology partners delivered adequate support for their efforts to meet meaningful use. Among these vendors, many users also reported being in the midst of attesting to Stage 2. Epic also had several respondents report that it was not an adequate partner in Stage 2 attestation, but given the high volume of users Epic engages with, the positive reviews significantly outweigh the negative.

Other vendors did not receive such favorable reviews, according to Peer60. Among those is McKesson, who received nearly double the percentage of negative reviews as positive ones. McKesson also has a substantial number of users who report still being in the process of attesting Stage 2. A few smaller vendors also received negative meaningful use reporting reviews, including NextGen and Practice Partners (which is owned by McKesson).

Of the practices surveyed, nearly 90 percent of them have either achieved Stage 2 or are in the middle of attestation. Fifty-six percent of respondents had successfully completed Stage 2 attestation, and 34 percent were in the thick of attesting. Only 10 percent had not successfully attested, and Peer60 reports that about half of those who had not been successful “simply don’t have the proper model to receive enough benefits to bother attesting.”

This report comes out after CMS released data regarding meaningful use registration and participation. Given that data, it appeared as though the delay in the release of the meaningful use modificationrules was hindering program growth. According to CMS, meaningful use enrollment stayed stagnant between the months of May and August. Medicare eligible professional (EP) enrollment also remained relatively the same between May and July, and skyrocketed in August. Likewise, eligible hospital (EH) enrollment stayed consistent between May and July and made a notable jump in August.

Now that the Stage 2 Meaningful Use Modifications Rule has been released, the rate of EHR Incentive Program enrollment may increase. Because the modified rule eliminates unnecessary and cumbersome requirements, as well as shortens the initial reporting period to 90 days, it is expected that more providers will enroll in the program and will be able to achieve success.

However, success could potentially be better facilitated by an EHR vendor that is more supportive and provides a product that works better with meaningful use. As such, EHR vendors may need to adjust their practices in helping providers meet meaningful use guidelines in order to remain competitive in the EHR market.

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Did Meaningful Use Requirements Propel Hospital EHR Adoption?

Did Meaningful Use Requirements Propel Hospital EHR Adoption? | EHR and Health IT Consulting |

Ever since 2009 when the Health Information Technology for Economic and Clinical Health (HITECH) Act became law, the majority of healthcare providers began adopting EHR systems and other health IT tools in order to meet the meaningful use requirements under the Medicare and Medicaid EHR Incentives Programs and avoid the financial penalties set for 2015 and the following years.

The Office of the National Coordinator for Health IT (ONC) and the Centers for Medicare & Medicaid Services (CMS) supported EHR adoption among hospitals and physician practices through a variety of resources and advisories. Recently, ONC released a data brief that outlines the high EHR adoption rates among hospitals and other providers.

The brief outlines the trends in the adoption of EHR technology between the years 2008 to 2014. ONC also tracked the implementation of certified EHR systems that meet meaningful use requirements as well as general health IT systems.

The results show that 76 percent of hospitals have a basic EHR system. This statistic has increased tremendously over the years, rising by 27 percent from 2013. Out of these reported hospitals, 97 percent have adopted certified EHR technology that meets meaningful use requirements under the EHR Incentive Programs.

Hospital EHR adoption varies significantly across states, ranging from 50 percent to 100 percent. Delaware, South Dakota, and Virginia have the highest rates of basic EHR adoption among hospitals. Kansas, West Virginia, and Hawaii were the three states with the lowest adoption rate of basic EHR systems.

State adoption of EHR systems has also risen significantly from 2008 to 2014, the ONC data brief shows. In 2008, only Connecticut and New Mexico had adoption rates of basic EHR systems above 20 percent.

By 2011, this statistic rose and 32 states had a hospital EHR adoption rate above 20 percent while seven states had a rate above 40 percent. By 2014, hospital EHR adoption rates were above 60 percent in 48 states and above 80 percent in 17 of those states. Clearly, these trends are rising significantly to meet meaningful use requirements and prevent the financial penalties under the EHR Incentive Programs.

The use of advanced functionalities within EHR systems is also increasing. For example, many more hospitals are using EHR technology that includes clinician notes. Additionally, 34.4 percent of hospitals have implemented comprehensive EHR systems in 2014.

Essentially, the adoption of EHR systems among acute care hospitals has quickly increased once the HITECH Act was passed in 2009 and providers began pursuing meaningful use requirements. State EHR adoption rates have also steadily increased among hospitals since the legislation was passed.

“A favorite question of mine, asked during the sessions and included in the report, is the following: ‘The real question is not what data we want to collect, but what problem are we trying to solve?’ I believe the real problem we are trying to solve is how to advance the public’s health wherever people live, work, learn or play, using information and data as a tool,” National Coordinator for Health IT Karen B. DeSalvo stated on the ONC website.

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Making Health IT Lead Patient Engagement Improvements

Making Health IT Lead Patient Engagement Improvements | EHR and Health IT Consulting |

Enhancing the quality of patient care and expanding patient engagement improvements are key areas that healthcare providers are focused on today. Through the utilization of new health IT tools, many medical professionals are seeing improvements in patient care processes throughout their practices.

Physicians’ Alliance, Ltd. (PAL) is one organization that has put their efforts into advancing patient care by adopting a leading analytics platform from Geneia, a vendor of software solutions for the healthcare industry.  PAL runs 22 practices throughout Pennsylvania and this analytics platform may lead to lowering medical costs and improving the quality of care for more than 500,000 patients, according to a company press release.

Victoria Martell, Quality Initiatives Coordinator at PAL, spoke with about some of their efforts toward improving patient care and the benefits of the new analytics platform. The organization has only implemented the technology within the last week and it may take more time to garner the exact advantages the analytics system will bring.

“I can tell from what little exposure I’ve had to it is that it’s definitely a powerful tool,” Martell said. “I’m very hopeful that it will provide us with a deeper dive into the information we’ll need to offer better care or identify areas of costs and utilization that can help us create better care management programs for our patients.”

The analytics platform may even “save the community and the patient [costs] in the long run.” Another Geneia client found that the platform offers information that can assist in lowering prescription costs and targeting patients that have high medical spending but have not seen their primary care provider in the last year.

According to Martell, analytics software and other health IT tools can help in “identifying patients that have gaps in their care such as quality measures, cancer screenings, adult immunizations, and patients with chronic diseases who haven’t had tests that monitor the diseases.”

“It will help us identify patients who might not have had those tests completed,” Martell explained. “In turn, we can reach out to them to ensure they are able to obtain the care that they need so we can better manage their conditions. This will also help prevent and identify diseases early on, so it will be more treatable.”

When it comes to using these tools for clinical analysis, Martell believes that they will improve patient health outcomes at PAL. The way this will be achieved is by identifying patients with gaps in their care and working on managing disease to prevent more serious or fatal outcomes.

“[These tools can help us by] identifying patients who have gaps in care especially with disease management,” Martell said. “If we’re able to identify patients who might not be seeing primary care providers or specialists regularly enough to help manage their chronic diseases, we can come up with a care plan strategy and a care team that leads to ultimately better care in the long run.”

Quality care and patient engagement improvements are also significant goals at PAL and Martell spoke about the processes and health IT tools needed to enhance the patient experience.

“Patient engagement is new and previously the patient would only sit and listen to the provider. Now technology allows for more availability of patients to reach out to providers rather than just a phone call. It is slowly coming around,” Martell mentioned. “We had a struggle early on with our patient portal. We struggled with having patients wanting to utilize the patient portal. Over time, they’ve seen the benefits of it and use it a lot now.”

“The Physicians Alliance is also a Level 3 Patient-Centered Medical Home. Obtaining this recognition, we had to demonstrate the ability to encourage patient engagement,” Martell explained. “Through our care teams and patient education that we have available, patients seem to be more apt to converse with us and ask questions. The providers have more time to spend with patients because we were able to shift things that the providers didn’t necessarily need to do [and transfer it over to] qualified nurses. This allowed the providers to have the time to sit and work with the patient.”

Victoria Martell also spoke on the benefits of EHR systems for impacting patient engagement improvements and patient care. When looking at the provider side of things, EHR technology can help enhance tracking of patient needs and helps improve efficiencies across a hospital or physician practice. The EHR system at PAL is able to flag reminders for clinical staff on any upcoming tests or immunizations patients may need.

When it comes to the new analytics platform, Martell said: “The system can integrate with our scheduling system and can compare what is needed for a patient and provide a ‘report card’ for that patient so that information can be used for an upcoming visit. It will help the nurse and provider team work with the patients to ensure that needed screenings are completed.”

Martell also discussed how Stage 2 Meaningful Use requirements have affected patient engagement improvements. PAL has reported Stage 2 Meaningful Use at their practices and Martell believes these requirements have increased patient engagement.

“One of the core elements of reporting [Stage 2 Meaningful Use] is patient engagement through the use of the patient portal. Prior to us striving to achieve Stage 2, our portal usage was not meeting the thresholds needed. We had to evaluate our workflows and how we presented portals to patients,” Martell stated. “Informing patients that they don’t need to sit on hold on the phone [by using the portal instead] really had increased patient awareness and we now see portal usage has substantially increased since July of 2014.”

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Preparation, Patient Engagement Key to Meaningful Use

Preparation, Patient Engagement Key to Meaningful Use | EHR and Health IT Consulting |

As the industry awaits the next set of objectives and measures for the Stage 3 rules of meaningful use next month, practices are still facing the challenge of meeting Stage 2 requirements for 2015.

Last month, CMS gave assurances of redefined Stage 2 rulemaking to help ease the reporting burden on providers. The forthcoming communication from CMS is intended to be responsive to concerns about software implementation, information exchange readiness, and other related concerns.

Despite the uncertainty, physicians will have to prepare for the Stage 2 rules of meaningful use for the calendar year.

In 2015, CMS data indicate more than 260,000 physicians will have to meet Stage 2 requirements. CMS estimates that more than 257,000 eligible professionals will receive payment penalties in 2015, which casts further doubt about the likelihood of high levels of physician participation.

Shaun Conrad, a manager in Ernst & Young's Americas Health Care Practice, said physicians have been having difficulty with some of the specific objectives of Stage 2.

"The biggest challenge is probably the electronic transmission and the patient portal," said Conrad. "Getting patients to engage can be very difficult and since the measure itself is reliant on the patient being engaged by logging into the portal, but they still need to view, download, or transmit that data in order for the provider to get credit ... there's a lot of changes there where you have to change your culture internally."

"Physician practices should look at having dedicated administrative staff help physicians manage meaningful use, Physician Quality Reporting System (PQRS), and other … quality-related incentive programs," said Rafi Tabib, managing consultant within Navigant's healthcare practice. "If possible, a well-rounded team with knowledge of the EHR functionality, reporting/data analytics, and program requirements, should be put together. The amount of dollars at stake in incentives and penalties warrants such a team."

Get the Data Moving

Mary Griskewicz, senior director of health information systems for the Healthcare Information and Management Systems Society, said she has seen work flow changes affecting her local family physician's office since it implemented an EHR.

"Since they've implemented EHRs they are much more thorough upon entry into the practice," Griskewicz said. "Now on the back-end, they should be giving the patient the information and follow-up instructions and, if they haven't signed up for your portal, let's get them signed up. That's the change in thinking and culture that's needed."

Naomi Levinthal, senior consultant and healthcare IT adviser for The Advisory Board Company, warns that transitions of care measures are incredibly complex and will require practices to know in advance how they will send summary of care records both internally and outside of their offices.

"Practices with a robust patient engagement initiative that includes clinician involvement may be able to meet the secure messaging [requirement] and view, download, and transmit measures of Stage 2 with greater ease," Levinthal said.

Levinthal said providers would be wise to focus on three key actions this year.

• Assign a practice staff person the responsibility to keep on top of meaningful use-related news, and determine whether there are any impacts to current plans.

• Be well-prepared for audits with a comprehensive book of evidence and an internal policy on how the practice would respond to an audit notice.

• Identify ways to align meaningful use with other practice initiatives, for example, electronic quality reporting or population health management.

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Public Health Objectives: Reporting Requirements in Stage 1 and Stage 2

Public Health Objectives: Reporting Requirements in Stage 1 and Stage 2 | EHR and Health IT Consulting |

Public health registry reporting is required for providers participating in the EHR Incentive Programs. Objectives include submitting data to an immunization registry, submitting data to a syndromic surveillance database, and submitting reportable lab results to a public health agency (for hospitals only).

How This Objective Improves Care
The meaningful use public health objectives foster data collection in a format that can be shared across multiple health care organizations. The availability of more and better data will help public health organizations monitor, prevent, and manage diseases to improve population health.

Stage 1 vs Stage 2 Requirements
Stage 1Eligible professionals and eligible hospitals must complete (or qualify for an exclusion for) at least one public health objective in Stage 1 of meaningful use.

Stage 2 – In Stage 2 of meaningful use, some of the Stage 1 public health menu objectives become core objectives, and new public health reporting requirements are added to the menu objectives. Eligible professionals must demonstrate (or qualify for an exclusion for) the capability to submit electronic data for immunizations, while eligible hospitals must demonstrate (or qualify for an exclusion for) the capability to submit electronic data for immunizations, reportable laboratory results, and syndromic surveillance.

Also in Stage 2, new public health menu objectives for eligible professionals include the capability to identify and report cancer cases to a cancer registry and specific cases to a specialized registry (other than a cancer registry).

How to Report Public Health Measures
Following are the steps for reporting in Stage 1 and Stage 2. For additional information on how to report public health measures, please visit the EHR website.

Stage 1
Year 1

  1. Select at least one public health menu objective
  2. Perform test of certified EHR technology’s capacity to submit electronic data, and follow-up submission if that test is successful

Year 2 (and Year 3 if Applicable):

  1. Submit data on an ongoing basis OR
  2. Show evidence of action taken that demonstrates both that another test is not beneficial in moving towards follow-up submission and that follow-up submission is not possible in year 2 (and year 3 if applicable)

Stage 2

  1. Report core public health objectives
  2. Select menu public health objectives (optional)
  3. Meet one of four criteria under the umbrella of ongoing submission

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Hospital Stage 2 Meaningful Use Attestations Near 77 Percent

Hospital Stage 2 Meaningful Use Attestations Near 77 Percent | EHR and Health IT Consulting |

The most recent update from the Centers for Medicare & Medicaid Services (CMS) puts the percentage of hospitals eligible having successfully attested to Stage 2 Meaningful Use at 77 percent.

In latest monthly meeting of the Health IT Policy Committee, Elisabeth Holland of the CMS Office of E-Health Standards and Services (OESS) reported that 1814 of 2115 eligible hospitals (EHs) had attested to Stage 2 Meaningful Use during the 2014 period as of the first of the year.

In late November, the federal agency extended the 2014 meaningful reporting deadline until December 31, giving these eligible providers an additional month to complete their 2014 meaningful use attestation.

Over that one-month period, the number of EHs successfully attesting for meaningful use reporting year 2014 rose from 3696 to 4093, with the EHs successfully attesting to Stage 2 Meaningful Use increasing from 1681 to 1814.

The total number of hospital attestations is slightly less than last year’s mark of 4112 total attestations for this portion of eligible providers.

During December’s meeting, the federal agency reported that number of EHs having successfully attested to Stage 2 Meaningful Use as of December 1 doubled from 840 to 1681.

The update comes one day after a group of industry associations voiced their support of a reintroduced bill to modify 2015 meaningful use reporting requirements, the Flexibility in Health IT Reporting (Flex-IT) Act of 2015 that would require a 90-day, quarter-based reporting period rather than a full year of reporting this year.

Support for the bill was bolstered by CMS data indicating that one-third of hospitals expected to demonstrate Stage 2 Meaningful Use in 2014 had to file for a hardship exception or meet Stage 1 requirements again, yet these figures and those provided yesterday by CMS do not add up.

Speaking of bad math, there is CMS data on eligible professionals over the same timeframe that raises questions. As of January 1, a total of 76,730 EPs demonstrated meaningful use in 2014, up from 60,561 EPs as of December 1. As for Stage 2, CMS data from the Health IT Policy Committee meeting incorrectly shows a decrease in successful 2014 Stage 2 Meaningful Use attestations — 16,455 to 16,359. (CMS is currently correcting those figures which will be made available shortly.)

The meaningful use attestation deadline for these eligible providers is set for the end of February. The number of EPs attesting to Stage 2 Meaningful Use has ample time to increase.

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Nebraska Docs Feel Pressure of Meaningful Use Requirements |

Nebraska Docs Feel Pressure of Meaningful Use Requirements | | EHR and Health IT Consulting |

Not long after the Centers for Medicare & Medicaid Services (CMS) unveiled its plans to send notices to eligible professionals to be subject to Medicare payment adjustments in 2015, stories about the challenge of meeting meaningful use requirements have once again emerged — two of which taking place in Nebraska.

Rick Ruggles (via Star-Herald) reports that some doctors in Nebraska are considering the worth of moving to certified EHR technology based on the costs associated with EHR acquisition and implementation.

“It’s a simple question of how much work for how much money, and will it help my patients,” Bob Rauner, MD, MPH, Medical Director, SERPA and Director of Partnership for a Healthy Lincoln,  told the news outlet. “The answer is now, no.”

Over the next few weeks, more than 250,000 providers eligible for the Medicare EHR Incentive Program will receive notice that they will be subject to Medicare payment adjustments beginning in 2015.

“We are getting ready to start mailing the letters to the eligible professionals who will be getting this payment adjustment and it is a number that is over 257,000,” CMS officials continued, “and these people will be paid one percent less of the Medicare Physician Fee Schedule amount that would otherwise apply for all their Medicare-covered professional services that they provide.”

The chief source of pain stems from the differences between Stage 1 and Stage 2 Meaningful Use such as health information exchange (HIE) and patient engagement via view, download, or transmit (VDT). Moreover, the requirement to exceed all measure thresholds in order to achieve meaningful use had some nervous about their performance.

“I was right on the brink of some of them,” Robert Wergin, MD, FAAFP, a physician and American Academy of Family Physicians (AAFP) President revealed about his own meaningful use experience. “It was kind of painful, really.”

Others such as 80-year-old physician, MD, are simply coming to terms with the reality that meaningful use penalties are coming their way.

“We’re doing the best that we can,” he explained. “If I get fined 1 percent, which is what they’ve threatened, that’s OK. I can afford it.”

Problems with patient engagement

Regional West Health Services (RWHS) is mindful of the cost of failing to meet the patient engagement requirement of Stage 2 Meaningful Use and it is a significant. According to another Star-Herald report, the Nebraskan health system puts the figure at $280,500 in lost federal incentives for “eight specific doctors” working at Regional West Physicians Clinic.

The health system is calling on patients to help these physicians reach the goal of five-percent patient use of the patient portal.

“You are the main person who sees the information, as well as staff who need access,” RWHS CMIO Usman Akhtar, MD, told the Star-Herald. “We need the support of the community.”

The health system has not specified how many patients the five percent equates to or the number of patient who have already access their health information through the patient portal.

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Meaningful use numbers show signs of life, groups still lobby for relief | Healthcare IT News

Meaningful use numbers show signs of life, groups still lobby for relief | Healthcare IT News | EHR and Health IT Consulting |
Stage 2 meaningful use attestations have shown big improvements recently, but many providers are still struggling. With her Flex-IT Act gaining traction in the House, Rep. Renee Ellmers, R-N.C., along with 28 fellow members of Congress, have called on HHS Secretary Sylvia Burwell to offer relief in the form of a shorter 90-day reporting period.

[See also: Poor MU showing renews calls for change]

The American Medical Association, meanwhile, is "appalled" that more than half of eligible providers will face penalties in 2015.

Speaking before the ONC's Health IT Policy Committee this past week, Elisabeth Myers, policy and outreach lead at CMS's Office of eHealth Standards and Services reported some drastic Stage 2 improvements.

[See also: New bill aims to ease MU reporting rules]

Hospitals, which had managed to log just 840 attestations through October, doubled that number between Nov. 1 and Dec. 1 – with 1,681 success stories as of the beginning of the month.

Eligible providers, meanwhile, managed another 5,000 successful attestations over the month – from 11,478 through Nov. 1 to 16,455 by Dec. 1.

For a program that seemed on such shaky ground as recently as this fall, those numbers are heartening. Still legislators and industry groups would like to see more. And a three-month reporting period in 2015, rather than a full year, would be one way to see even more success, argues Ellmers, along with more than two dozen, mostly-Republican colleagues, in a Dec. 16 letter sent to HHS.

"We remain convinced that program success hinges on addressing the 2015 reporting period requirements," Ellmers wrote, asking that HHS "immediately provide" a shortened, 90-day reporting period in 2015, "which would give providers much-needed time to safely and effectively implement certified technology and continue their 'meaningful use' journey."

Full-year reporting will "complicate the forward trajectory" of the program and "jeopardize the $25 billion in federal investment made to date," she wrote.

"Our constituents remain concerned that the pace and scope of change have outstripped the capacity of our nation’s hospitals and doctors to comply with program requirements," wrote Ellmers, who co-sponsored the Flex-IT Act this past September, in answer to outcry over CMS holding fast on its 365-day reporting period – a move that "disregarded recommendations made by the vast majority of healthcare stakeholders."

On Wednesday, CHIME President and CEO Russell P. Branzell issued a statement in support of the letter.

CHIME, he said, "applauds the leadership" Ellmers and her colleague, Rep. Jim Matheson, D-Utah, "have shown on this important, bipartisan issue and are pleased their colleagues recognize how essential meaningful use is in the modernization of the nation’s healthcare delivery system."

He added that December data from CMS showing that about half of the nation's physicians will receive penalties in 2015, "only validate our calls for increased program flexibility."

Indeed, that penalty data had the AMA hopping mad on Wednesday.

The AMA, said President-Elect Steven J. Stack, MD, is "appalled" by the news that more than 50 percent of eligible professionals will face penalties under the meaningful use in 2015.

That's "a number that is even worse than we anticipated," he said.

"The AMA supported the original HITECH legislation and we have provided extensive and constructive feedback to the administration to help fix the meaningful use program, but few changes have been made," wrote Stack.

The penalties faced by docs under meaningful use "are part of a regulatory tsunami facing physicians, apart from the flawed Sustainable Growth Rate formula, that could include cuts from the Physician Quality Reporting System, the Value-based Modifier Program and the sequester, further destabilizing physician practices and creating a disincentive to see Medicare patients," he added.
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Stage 2 just too tough? | Healthcare IT News

Stage 2 just too tough? | Healthcare IT News | EHR and Health IT Consulting |

In November, a fresh batch of disheartening Stage 2 attestation numbers prompted several industry groups to once again implore the Centers for Medicare & Medicaid Services for relief.

CMS numbers released Nov. 4 show that fewer than 17 percent of U.S. hospitals have demonstrated Stage 2 capabilities. Even worse, fewer than 38 percent of eligible hospitals and critical access hospitals have met either stage of meaningful use in 2014.

As for eligible professionals, just 2 percent have managed to meet Stage 2 so far, and it seems unlikely that very many more will have reached that threshold by the Feb. 28, 2015, attestation deadline.

Officials from the AMA, CHIME, HIMSS and MGMA said in a joint press release that the numbers are "disappointing, yet predictable," and reiterated their calls for CMS to offer more leniency to help address providers' widespread difficulty in meeting federal electronic health record requirements.

"Providers have struggled mightily in 2014, in many instances for reasons beyond their control," said CHIME CEO Russell Branzell. "If nothing is done to help them get back on track in 2015, we will continue to see growing dissatisfaction with EHRs and disenchantment with meaningful use."

Given the disappointing numbers so far, and the "tremendous number of providers required, but likely unable to fulfill, Stage 2 for a full 365-days in 2015," the stakeholders have asked CMS numerous times for a shortened, 90-day reporting period in 2015.

If CMS continues to hold fast on a full-year of reporting data for 2015, she said, "we anticipate that large segments of providers will no longer be able to participate in the program," said Carla Smith, executive vice president of HIMSS.

It was a common refrain in the second half of 2014, as it became more and more clear just how hard a time hospitals and practices were having complying the stringent measures of Stage 2.

Beyond a shorter reporting period, many have called for more flexibility, especially around problematic measures around electronic transmission of care summaries and patient access,

"CMS must end its one-size-fits all approach to achieve the goals of the meaningful use program, which are to create a secure and interoperable infrastructure," said AMA President Elect Steven J. Stack, MD. "We believe the stringent pass fail requirements for meeting meaningful use, combined with a tsunami of other overlapping regulations, are keeping physicians from participating in the meaningful use program."

At the CHIME 2014 Fall CIO Forum in October, a big topic of concern is is the start of Medicare penalties in 2015 for hospitals failing to meet those meaningful use standards.

As Healthcare IT News contributor Neil Versel reported, CHIME Vice President for Public Policy Jeff Smith said the dearth of hospitals with Stage 2 success was a "troubling" trend – never mind the fact that "hospitals, by comparison, are leagues ahead" of their physician practice counterpart.

Even if thousands more docs were to attest to Stage 2 before the end of the year, he pointed out, the vast majority of more than half a million EPs are at risk of being penalized.

That, said Smith, means many will be calling their representatives in Congress – and about the only thing Congress knows how to do with something like meaningful use is to kill it, Versel wrote.

"I think meaningful use has been to a degree a victim of the federal rule-making process," Smith said. "We're still engaged with CMS to try and figure out a way to make these (attestation) numbers better," said Smith.

CMS has made conciliatory gestures – such as reopening the submission period for meaningful use hardship exception applications (some 44,000 providers applied for exceptions before the initial deadline). But for the most part it has held firm on MU's most contentious measures, so far.

Meanwhile, exasperation has only increased.

"I've never seen this level of frustration in our membership, as I have in the past six to eight months or so," says MGMA Senior Policy Advisor Robert Tennant. "It's not just meaningful use. But that is certainly one of the catalysts."

What that means for the future of a program that initially showed so much progress remains to be seen.

In September, an alphabet soup of industry groups – HIMSS, CHIME, MGMA  AMA, AHA and AAFP co-signed a letter to CMS in which they reiterated their concerns that "the pace and scope of change had outstripped our collective capacity to comply with meaningful use requirements," and warned that continued intransigence on the rules could result in otherwise well-meaning providers "having to drop out of the program."

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Three Vendors are Driving Patient Engagement and Portal Use

Three Vendors are Driving Patient Engagement and Portal Use | EHR and Health IT Consulting |

Driving patient engagement is still vital for the healthcare sector despite certain inconsistencies from the Centers for Medicare & Medicaid Services (CMS). Even though CMS has proposed new Stage 2 Meaningful Use regulations that drop the 5 percent requirement of patients viewing, downloading, and transmitting their health information to just one patient per provider, the organization still expects eligible professionals and hospitals to meet a much larger percentage – currently proposed to be 25 percent – of patients viewing their medical data through patient portals under the Stage 3 Meaningful Use requirements. As such, providers would be wise to continue integrating patient engagement strategies at their facility.

Vendors play a vital part in developing effective patient portals to assist providers in driving patient engagement among their community of consumers. A report from the research firm KLAS examined which vendors in particular have been most useful in moving forward patient portal adoption amidst healthcare providers.Driving Patient Engagement

Athenahealth, Epic, and Medfusion were reported to be at the top of their game when it comes to increasing portal adoption throughout the patient population. More than half of the customers under all three vendors report that at least 20 percent of their patients have accessed the patient portal. This is well above the previous 5 percent threshold that CMS initially unrolled under Stage 2 Meaningful Use regulations.

KLAS discovered these findings after interviewing 186 medical provider organizations on which vendors have really made a difference in meeting their needs and advancing health IT and patient engagement for a brighter tomorrow.

The KLAS report focused on three main areas regarding patient portal strategies: enterprise, ambulatory, and EMR agnostic. A variety of factors associated with increasing patient portal adoption were addressed in the report including product performance and vendor guidance.

“Value-based care is forcing patient portals to evolve from being merely tools for reactive regulatory compliance to becoming valuable instruments that allow patients to proactively engage in their own care,” said report author Coray Tate. “Providers report that vendor guidance and functionality that patients find useful, such as billing and self-scheduling, are the most effective ways to encourage portal adoption among patients.”

A study published by the American Health Information Management Association (AHIMA) further outlines the use of the patient portal particularly among teenagers and parents. The researchers studied the attitudes of these two groups through one teen digital bulletin board, one parent digital bulletin board, and two focus groups for each faction. Videos and transcripts from the sessions were then analyzed.

The results showed that both teenagers and parents found that patient portals are beneficial and should be used to help teens better manage their own healthcare. Some teenagers were concerned that physicians would not be keeping certain information private and will let their parents see data that is meant to be protected. One parent said: “This kind of access will help my teen become much more interested in her healthcare and also motivate her to take control. And that will be great.”

With greater teamwork between vendors, providers, and the patients themselves, there should be a rise in the use of portals and patient engagement.

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EHR Incentive Programs Modified in New Proposed Ruling

EHR Incentive Programs Modified in New Proposed Ruling | EHR and Health IT Consulting |

The Centers for Medicare & Medicaid Services (CMS) released a proposed rule on April 10 announcing specific modifications to the EHR Incentive Programs. The most important aspect of these modifications is the change to the reporting period in 2015 to a 90-day period in line with the calendar year and a similar EHR reporting period for the following year.

Previously, the meaningful use requirements would pose a financial penalty on eligible providers and hospitals that did not meet the objectives of the EHR Incentive Programs for a full calendar or fiscal year. CMS also proposed changing the reporting year for hospitals from the fiscal to the full calendar year in order to have both eligible professionals and hospitals reporting during the same time period.

Another area that the modified proposed rule affects is the patient action measures, which are part of the Stage 2 Meaningful Use requirements regarding patient engagement. The proposed rule simplifies the meaningful use regulations by removing certain reporting mandates that have become redundant or duplicative due to a variety of improvements in EHR function since the inception of the Medicare and Medicaid EHR Incentive Programs.

Comments to this proposed rule need to be sent to CMS electronically, by regular mail, via express mail, or by courier no later than 60 days after the publication of the ruling. The modifications bring greater focus to the advanced use of EHR systems and attempt to align the Stage 1 and Stage 2 Meaningful Use requirements from 2015 to 2017 with the Stage 3 Meaningful Use regulations, which are expected to be reported to CMS starting in 2018.

The document explains that the meaningful use stages under the EHR Incentive Programs continue to have an important goal of increasing EHR interoperability among providers and hospitals. In order to reduce redundancy, CMS is modifying the number of objectives and measures that providers need to meet to demonstrate meaningful use of EHR technology.

The proposed ruling document discusses how the requirement mandating that more than 5 percent of patients view and download their health information is causing undue burden on healthcare providers. CMS offers a major change to this requirement through the years 2015 to 2017. Under the modified proposed ruling, only one single patient will need to view, download, or transmit their medical information to a third party.

Additionally, CMS proposes the secure electronic messaging objective under Stage 2 Meaningful Use requirements to no longer have a 5 percent threshold but instead have a yes/no reporting requirement asking providers to attest to the statement: “The capability for patients to send and receive a secure electronic message was enabled during the EHR reporting period.”

Another modified proposal CMS put forward is to perform a security risk analysis including addressing data encryptions in certified EHR technology and adopting security updates as necessary during the EHR reporting period.

CMS hopes that these modifications will provide more flexibility to eligible hospitals and providers attempting to meet meaningful use requirements under the EHR Incentive Programs.

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How to Properly Implement Patient Portals for Meaningful Use

How to Properly Implement Patient Portals for Meaningful Use | EHR and Health IT Consulting |

Even though the Stage 3 Meaningful Use proposed rule is now dominating the public dialogue about the EHR Incentive Programs, many healthcare providers are still struggling to meet Stage 2 Meaningful Use regulations. One of the key issues that concerns providers is the difficulty of increasing patient engagement and the use of patient portals.

Having patients be more aware and have more control over their own health is necessary to ensure better patient outcomes and quality of care. The Centers for Medicare & Medicaid Services (CMS) state on their website these intentions as their primary reason for emphasizing patient engagement in Stage 2 Meaningful Use requirements under the Medicare and Medicaid EHR Incentive Programs.

Stage 2 Meaningful Use calls for more patient-centered care that includes providing patients with access to download and view their electronic health information through portals. Additionally, providers are encouraged to send patient follow-up reminders and preventive care correspondence.

Providers will need to ensure that more than 5 percent of their patients access their data through patient portals and utilize secure messaging tools to speak with their physician. In order to assist providers in meeting these requirements, the Office of the National Coordinator for Health IT (ONC) provides a fact sheet to assist in the implementation of patient portals.

First, ensuring a portal is user-friendly and engaging is key in meeting this requirement under Stage 2 Meaningful Use. Transitioning toward using this technology during clinical examinations or treatments may improve decision-making, patient-physician communication, and self-care support.

Often, the older population may not be as tech-savvy with regard to accessing their health data through a patient portal. ONC suggests training these patients to use the tools and services available through a portal.

Some key actions that providers should take to improve patient engagement is to implement proactive and engaging features as well as promote and expedite portal use. There are a variety of benefits providers gain from portals such as efficient and effective communication channels with patients, greater self-care initiative from patients, and higher patient satisfaction.

Stage 2 Meaningful Use requirements call for providing patients with clinical summaries, patient-specific education support, secure messaging tools, follow-up care or preventive health reminders, and access to their medical records.

When developing a patient portal, it is useful to have interactive features that are relevant to patient needs. A portal should go beyond merely scheduling features and a method for displaying lab results. Incorporating decision tools and secure messaging capabilities will catalyze the regular use of patient portals. For additional expertise in implementing patient portals, the ONC fact sheet recommends providers to seek the assistance of regional extension centers (RECs).

Currently, patient portals are expanding not only nationwide but also across the globe. A press release from Frost & Sullivan emphasizes the high adoption rate of patient portals in Africa.

“The ability of patient portals’ to optimize the operational and financial efficiency of healthcare providers and payers by leveraging time-saving technologies is a key purchasing factor,” Frost & Sullivan Healthcare Research Analyst Saravanan Thangaraj said in the company press release. “Further, it can ease some of the tedious and monotonous administrative, as well as data-entry, tasks that consume hospital resources. Patient portals also eliminate the need for additional staff and postage by enabling patients to perform functions online.”

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ICD-10 Compliance, Stage 2 MU Prompt More IT Adoption

ICD-10 Compliance, Stage 2 MU Prompt More IT Adoption | EHR and Health IT Consulting |
The healthcare industry is on track for spending billions of dollars on health IT products throughout 2015. With the ICD-10 compliance deadline looming in October, most providers are looking to adopt advanced IT systems that incorporate the new ICD-10 coding set.

Almost 60 percent of polled hospitals leaders stated they will be focusing on transitioning to ICD-10 compliance throughout 2015, according to a report from peer60. Some typical IT products many may be purchasing include revenue cycle management, population health management, patient engagement, EHR, and ICD-10 migration systems.147504495

The researchers also broke down the surveyed hospitals by size and found that the bigger organizations are more likely to invest in health IT technology over the next year due to having more resources to spend. However, the report also discovered that very small hospitals are more likely to purchase an EHR system when compared to larger medical facilities.

It is likely that larger hospitals already have EHR systems set up and are looking toward health IT than can better coordinate care, engage patients, and provide analytics. Additionally, every hospital with over 1,000 patient beds was planning on purchasing a major IT solution in 2015.

EHR vendors are likely to remain busy throughout this year, as 27 percent of surveyed hospitals are looking to either replace a current EHR system or install a new one in the ambulatory care setting. Additionally, 31 percent of those looking to replace a system are undecided on whether to purchase from their previous vendor. This means that around one in ten hospitals will be changing their EHR vendor.

The data analytics market is also emerging among health IT systems. Despite it being a new avenue, 26 percent of hospital leaders said they are planning to buy an enterprise analytics suite in 2015, with 30 percent of these tools being first time purchases. Chief Information Officers (CIOs) were the key positions that were looking to incorporate analytics systems in their healthcare facilities. Additionally, 25 percent of those who already have analytics products are looking to update and replace their systems with more enhanced features. Nonetheless, 40 percent of the survey takers are unsure whether they will be renewing their data analytics software.

With Stage 2 Meaningful Use requirements calling for greater patient engagement and the creation of patient portals among medical facilities, the healthcare sector is poised to incorporate more patient-centric solutions. However, the report found that 40 percent of hospital leaders have not picked a patient engagement strategy as of yet. Regardless, 48 percent of hospitals will be addressing patient engagement in 2015.

Others in the industry are already choosing replacement products to increase patient engagement at their facilities. With many looking to leave their current health IT vendor, there is definitely a market for product replacement aimed toward improving the patient-doctor relationship. Smaller hospitals are still considering their options.

Along with data analytics and patient engagement, more providers are looking for health IT products that improve population health management. All of these resources should move the healthcare sector toward enhancing the quality of care and patient safety over the coming years.
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Latest MU Results Offer Something to Ponder

Latest MU Results Offer Something to Ponder | EHR and Health IT Consulting |

When is a surprise not a surprise? That might be a question to ask some of the Doubting Thomases in healthcare and healthcare IT these days. Because, honestly, when the initial meaningful use Stage 2 attestation numbers came out late last fall, the sense of “I told you so” was fairly strong among many in healthcare. As our Senior Editor, David Raths, reported in November, a number of healthcare association leaders noted that the fact that only 840 hospitals had attested to Stage 2 at that point, and many were ready to declare the entire meaningful use process a failure.

And many had very legitimate concerns, given the level of challenges providers have been facing going into and through Stage 2. But I will say that I, for one, had always trusted the industry observers who had expected most attestations to come at the very last moment. And that is exactly what’s happened.

As David Raths reported on Jan. 14, “With one month left in the 2014 reporting period, 77 percent of hospitals eligible to attest to Stage 2 of the meaningful use program have already done so, according to figures presented at the Jan. 13, 2015, HIT Policy Committee meeting.” As he further reported, “Concerns about low attestation rates earlier in 2014 may have been mitigated by two factors, explained Elisabeth Myers from the Office of E-Health Standards and Services at the Centers for Medicare & Medicaid. First, most eligible hospitals tend to attest after their fiscal report year closes, and that held true this year… Second is the fact not all hospitals and providers are eligible for Stage 2 in 2014.” And as Paul Tang, M.D., the committee’s co-chair, noted, the phenomenon of hospitals waiting until the end of the fiscal year is tracking with a pattern from previous years.

So the plain fact is that more than three-quarters of the hospitals eligible to attest in 2014 have now done so. And that’s a good thing. Are they facing an uphill battle going into 2015? Absolutely. Will some fail to make it successfully to and through Stage 3? Quite possibly.

But it’s important to consider that, in the context of this arduous journey of meaningful use, this 77 percent statistic is significant, and should not be minimized.

Meanwhile, it is interesting to note that only 200 hospitals will see payment adjustments as of this moment, and the number set to get adjustments of more than $5,000 is going to be quite small.

So as challenging as everything looks right now, there is definitely reason for a very cautious flavor of optimism. While this is no time for early victory laps, perhaps things in MU Land are not as dire as some of the Debbie Downers might have led us to believe, either.

And then of course, Stage 3 is now very much on the horizon. As Jeff Smith of CHIME noted earlier this week, “Stage 3 proposed rules are currently under review at the Office of Management and Budget (OMB)—the last step before being released for public comment.” And, Smith noted, “The Stage 3 Notice for Proposed Rulemaking (PRM) process is the most likely vehicle CMS and the Office of the national Coordinator for Health IT (ONC) could use to make changes that CHIME and other stakeholders have been advocating. This is the best chance,” he added, “to make substantive changes to meaningful use and revive an ailing program.”

So we’ll see what happens. Doubtless, the next several months will be pivotal for the meaningful use program going forward. So stay tuned. And keep your powder dry.

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Accountable Care, Patient Portals Lag behind Expectations

Accountable Care, Patient Portals Lag behind Expectations | EHR and Health IT Consulting |

The slow uptake of accountable care reimbursement structures and the low implementation rates of advanced patient portals are among some of the top issues in healthcare over the past year, according to HIMSS Analytics, and present both challenges and opportunities for the industry as it moves forward into reforms that encourage patient engagement, individualized care, and higher quality outcomes.   While mobile technologies and telemedicine are enjoying widespread interest and use among healthcare providers, opportunities to increase adoption of health IT, improve patient engagement, and provide better patient care abound in the year to come.

“Patient engagement is more than just today’s hot topic – it is foundational to the future of healthcare,” said HIMSS Analytics Research Director Brendan FitzGerald.  Yet few providers who have patient portals have selected software that allows patients to truly engage with them, the organization found.  Sixty-two percent of hospitals are live on a portal, but just 23% can allow patient users to view their personal health record or lab results.  Without functionalities that encourage patients to visit the portal site on a regular basis or offer features that patients have expressed preference for, healthcare providers may find themselves struggling with Stage 2 meaningful use throughout 2015.

Despite the slow adoption of feature-rich portals, telehealth seems high on the agenda of many organizations.  Nearly half of organizations have adopted up to four different telehealth technologies, including two-way video conferencing, which is viewed as the best entry-level investment for providers looking to dive into the telehealth sphere.

“Organizations continue to strive toward a value-based rather than volume-based care model, and many telemedicine technologies can aid in that transition,” FitzGerald said in August. “However, the study found that organizational needs will vary based upon provider type while the numerous technologies under the telemedicine umbrella will add to the complexity of the market.  Regardless of these challenges, organizations will continue to look for and utilize technology to fill gaps and enhance initiatives in patient care.”

But adoption of those value-based principles continues to be slow for the majority of the industry.  Only a quarter of providers have a clear and defines strategy that centers on accountable care.  While the number of accountable care organizations is growing by the day, organizations may be more focused on attempting to successfully attest to Stage 2 meaningful use instead of shouldering more financial risk under a value-based reimbursement structure.

Instead, they may turn to mobile technologies as a simpler way to coordinate care, improve communication, boost efficiency, and cut waste.  “It’s one thing to state that mobile technology is cool; it’s another to determine what value it brings to the healthcare equation,” said David Collins, Senior Director, Health Information Systems for HIMSS North America.

Providers certainly see that value as increasing demands on their time make on-the-go access to EHRs, clinical decision support, and other information a necessity.  More than half of hospitals already use mobile devices such as smartphones and tablets, with 69% of providers using the technologies to access clinically-related apps.  Thirty-six percent of clinicians believe that mobile devices such as tablets and smartphones will be instrumental for reducing redundancies and improving efficiencies, which may indicate a bright future for pocket-sized computing in healthcare.

“The study found that organizational needs will vary based upon provider type while the numerous technologies under the telemedicine umbrella will add to the complexity of the market,” FitzGerald concludes.  “Regardless of these challenges, organizations will continue to look for and utilize technology to fill gaps and enhance initiatives in patient care.”

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More Responses to Meaningful Use Penalties, Participation |

More Responses to Meaningful Use Penalties, Participation | | EHR and Health IT Consulting |
Members of Congress and CHIME respond to reports of meaningful use penalties and participation figures.

In the span of one week, the Centers for Medicare & Medicaid Services (CMS) released two telling pieces of information regarding the Medicare EHR Incentive Program — meaningful use penalties and Stage 2 Meaningful Use attestation — both being used by a cohort of Congress members and one industry association as proof of the need for immediate changes to 2015 meaningful use requirements.

As part of this month’s the Health IT Policy Committee meeting, CMS reported that 1,681 eligible hospitals (EHs) had successfully attested to Stage 2 Meaningful Use as of December 1, doubling the last month’s figure 840 EHs successfully attesting as of November 1.

This revelation motivated 30 members of Congress (28 Republicans and 2 Democrats) to call on the Department of Health & Human Services to reduce the 2015 meaningful use reporting from a full year to a 90-day quarter.

“We recognize that the Meaningful Use Program has been a catalyst in the widespread adoption of health information technology across the country,” the letter from the group led by Representatives Renee Ellmers (R-NC) and Jim Matheson (D-UT) states. “However, we remain convinced that program success hinges on addressing the 2015 reporting period requirements.”

Ellmers and Matheson are co-sponsors of the Flexibility in Health IT Reporting (Flex-IT) Act of 2014, which they introduced in the House of Representative in September and currently sits with the House Energy & Commerce and Ways & Means Committees.

According to the most recent letter to HHS Secretary Sylvia M. Burwell, the subscribers contend that a failure to reduce “will complicate the forward trajectory of Meaningful Use and jeopardize the $25 billion in federal investment made to date.” Moreover, the group claims that feedback to the flexibility rule published by HHS and CMS in the Federal Register in September calling for a reduced 2015 meaningful use reporting period were “disregarded.”

The more recent news that more than 257,000 providers eligible for the Medicare EHR Incentive Program will receive notice that they will be subject to Medicare payment adjustments beginning in 2015 in the coming weeks has another supporter of the Flex-IT Act urging CMS to move quickly to address 2015 meaningful use reporting requirements.

That supporter is the College of Healthcare Information Management Executives (CHIME), which released a statement Thursday:

Data released today by CMS, indicating that roughly half of the nation’s physicians will receive penalties in 2015, only validate our calls for increased program flexibility. CHIME applauds the leadership Representative Renee Ellmers (R-NC-02) and Representative Jim Matheson (D-UT-4) have shown on this important, bipartisan issue and are pleased their colleagues recognize how essential Meaningful Use is in the modernization of the nation’s healthcare delivery system.

Despite calls from Congress and industry associations, neither HHS nor CMS has hinted at the possibility of modifying the EHR Incentive Programs in 2015.

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Millennials want personal health records on the go | Healthcare IT News

Millennials want personal health records on the go | Healthcare IT News | EHR and Health IT Consulting |

Could younger patients be the key to achieving Stage 2 meaningful use patient access requirements? A new report finds strong desire for online medical records among the 18- to 34-year-old generation, with 43 percent of millennials saying they want to access their portals via smartphone.

In its fifth annual survey on the usage of electronic health records, Xerox sees more and more Americans expecting and demanding online access to health data. While aging Baby Boomers are showing keen interest in online access, Millennials are also increasingly expecting they can see their medical information where and when they want it.

The poll shows that the younger generation is much more interested in their medical records (to the tune of 57 percent) than any other content contained in online patient portals. They also say they'd like more personalized recommendations to improve their health and tips about additional services from their doctor (44 percent each).

The survey of 2,017 U.S. adults found that nearly two-thirds (64 percent) of those polled don't use online patient portals at all; still, more than half of that group (57 percent) say they'd be much more interested and proactive in their personal healthcare if they had online access to their medical records.

Many patients are unaware that such tools even exist, according to the report. Among those who don't use patient portals, 35 percent didn't know they were available to them and 31 percent said their physician had never mentioned them. Among Americans who do use PHRs, meanwhile, 59 percent say they have been much more interested and proactive in their personal healthcare since they received access.

"With providers facing regulatory changes, mounting costs, and patients who increasingly seek access to more information, our survey points to an opportunity to address issues by simply opening dialogue with patients about patient portals," said Tamara St. Claire, chief innovation officer of Xerox's commercial healthcare division, in a press statement.

With Stage 2 meaningful use's 5 percent view/download/transmit requirements still vexing many providers, the survey suggests that better educating both Millennials and Baby Boomers about portals could help increase patient engagement, accoding to Xerox.

If Millennials expect easy and mobile access to health records and wellness data, Boomers are more interested in using online access to manage their chronic conditions -- and in even greater numbers than younger, arguably more tech-savvy patients -- the poll shows:

  • Those who don't use PHRs say they'd be more engaged in their care if they received access to medical information online (56 percent of those ages 55 to 64, and 46 percent of those ages 65 or older).
  • Those ages 55 to 64 accounted for the highest percentage (83 percent) of Americans who say they already do or would communicate with healthcare providers via a patient portal.
  • Some 70 percent of Boomers say they do or would schedule appointments; 64 percent access/review medical records/test results; 60 percent ask their physicians questions; 58 percent order prescription refills, and 40 percent request a referral.

Providers able to guide "different generations to take advantage of the information available at their fingertips" could see gains in meaningful use readiness and chronic disease management, said St. Claire in a statement. "Educating patients will empower them to participate more fully in their own care while helping providers demonstrate that electronic health records are being used in a meaningful way."

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Stage 2 'flexibility' rings hollow for many | Healthcare IT News

Stage 2 'flexibility' rings hollow for many | Healthcare IT News | EHR and Health IT Consulting |

When the Centers for Medicare & Medicaid Services published its final rule for Stage 2 meaningful use on Aug. 29, it trumpeted the "flexibility" it offered for how providers can use certified electronic health records.

Specifically, the rule allowed providers to use the 2011 Edition certified EHRs, or a combination of 2011 and 2014 Edition technology for the reporting period in 2014. By 2015, all eligible professionals, eligible hospitals, and critical access hospitals are required to use the 2014 Edition certified IT.

“We listened to stakeholder feedback and provided CEHRT flexibility for 2014 to help ensure providers can continue to participate in the EHR Incentive Programs forward,” said CMS Administrator Marilyn Tavenner, in a press statement.

But industry groups did not feel listened-to. And they definitely did not see much in the way of flexibility – at least when it came to reporting periods – a topic on which they'd lobbied particularly hard.

"CHIME is deeply disappointed in the decision made by CMS and ONC to require 365-days of EHR reporting in 2015," said Russell P. Branzell, chief executive officer of the College of Healthcare Information Management Executives, in a press statement responding to the new rule.

"This means that penalties avoided in 2014 will come in 2015, and millions of dollars will be lost due to misguided government timelines," he added. "Now, the very future of meaningful use is in question."

Other stakeholders were similarly wary of CMS' next steps. Even the day before that final rule, MGMA Policy Advisor Robert Tennant (perhaps intuitively sensing what it would contain), told Healthcare IT News that, "We've raised numerous concerns about where meaningful use is going. If significant changes are not coming in the program, I think the program risks a lot. We could see, frankly, failure of the program."

In mid-September, CHIME, MGMA and more than a dozen other stakeholders joined forces to write a pointed letter to HHS Secretary Sylvia Mathews Burwell – Tavenner and National Coordinator for Health IT Karen DeSalvo, MD, were CC'd – to reiterate their serious concern that the success of meaningful use "hinges on addressing the 2015 reporting period requirements.

While the groups – which included HIMSS, the American Medical Association, the American Hospital Association and more – thought their concerns had been heard and would be acknowledged in the Aug. 29 rule, they "were surprised to learn that flexibilities meant to mitigate 2014 challenges did not also address program misalignment in 2015 and beyond."

The numbers speak for themselves, the groups argued. As of September, just 143 hospitals and 3,152 providers have been able to meet Stage 2 with 2014 Edition EHRs.

"This represents less than 4 percent of the hospitals required to be Stage 2-ready within the next 15 days," according to the letter. "And while eligible professionals have more time, they are in comparatively worse shape, with only 1.3 percent of their cohort having met the Stage 2 bar thus far."

While the stakeholders reiterated their commitment to meaningful use, they urged Secretary Burwell to "take immediate action by shortening the 2015 EHR reporting period to 90 days" – and also by adding more wiggle room with regard to Stage 2's notoriously troublesome transitions of care and view/download/transmit measures.

The very next day, a new bi-partisan bill seeking to offer providers meaningful relief was drafter on Capitol Hill. Republican North Carolina Congresswoman Renee Ellmers introduced H.R. 5481, The Flexibility in Health IT Reporting (Flex-IT) Act of 2014, on Sept. 16.

Co-sponsored with Democratic Utah Rep. Jim Matheson, the new legislation is crafted to offer providers more flexibility in showing meaningful use compliance. Specifically, according to Ellmers' office, it would remedy HHS' "short-sighted final rule" requiring 365 days of EHR reporting in 2015.

The Flex-IT Act would allow providers to report their technology upgrades in 2015 through a 90-day reporting period as opposed to a full year. It would be welcome relief for legions of providers, who say the shortened reporting window would help them better manage meaningful use's many onerous mandates.

"The meaningful use program has many important provisions that seek to usher our health care providers into the digital age," said Ellmers in a press statement. "But instead of working with doctors and hospitals, HHS is imposing rigid mandates that will cause unbearable financial burdens on the men and women who provide care to millions of Americans. Dealing with these inflexible mandates is causing doctors, nurses, and their staff to focus more on avoiding financial penalties and less on their patients."

By giving providers the option to choose any three-month quarter for the EHR reporting period in 2015 to qualify for MU, "hundreds of thousands of providers" would have a better shot of meeting Stage 2 requirements safely and effectively, she said.

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